HomeMy WebLinkAboutR2021-0227 - Permit ApplicationDocuSign Envelope ID: 604CC316-tA3A-4447-8374-1D038FCE7A2C
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
00 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# W L www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
_.._... ---. - . -.....I ..--- --..__ , ....... - -- -- --
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 7304 West Oceanfront City: Newport Beach State: CA Zip:
Property Owner: Saumil H. Parikh
Owner Address:
State: CA Zip Code:
Zip Code:
City:
Home Phone:
Owner's Authorized Agent: Steve High Work Phone:
Agent Address: 450 Newport Center Drive, suite 100 City:
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow, Inc.
Escrow Address: 450 Newport Center Drive, 230 City:
State: CA
Zip Code: 92660
Email Report To: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
Beach
Escrow # 005432 -BR
Beach
Escrow Phone: (949)698-1960
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
or
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection:
Date:
�
Owner/ Agent's signature to decline inspection: I ,�"- Nvf�. Date: 3/24/2021
Account #2900-5005 ...... ..... Make checks payable to CITY OF NEWPORT BEACH